Donor quality of life before and after adult-to-adult live donor liver transplantation

Abstract

Background: Donor right hepatectomy subjects a healthy donor to an ultra-major surgical operation only for the benefit of the recipient. This has become a standard treatment modality to partially relieve the refractory shortage of cadaveric liver grafts. Justification of this procedure ought to be made with the full knowledge of the potential negative effects on the donor. Psychosocial assessment and monitoring of the donor has to be an integral part of such program. Aim of study: To quantify the impact of donor right hepatectomy including the middle hepatic vein on donor quality of life before and after surgery longitudinally. Materials and Methods: Questionnaires with condition specific and generic components were completed by a face-to-face interview by one of the two full-time liver transplantation coordinators before operation, and 1, 2, 3, 6, and 12 months after operation. The generic instruments used were Karnofsky Performance Status, and the Chinese (Hong Kong) version of the Medical Outcomes Study 36-Item Short-form Survey. The latter measures eight concepts: physical functioning, physical role, emotional role, social functioning, bodily pain, mental health, vitality, and general health. Condition specific questions were also included. Results: Between November 2002 and November 2003, 30 consecutive donors who underwent donor right hepatectomy including the middle hepatic vein were assessed and monitored prospectively before and after surgery. They were aged 35 years (21 to 56), with male to female ratio of 33.3%:66.7%. The median follow-up was 6 months (2 to 12). All except 1 were Chinese (1 Indian). There was no donor mortality or major complications. All the donors completed the questionnaires on schedule. Donor quality of life before surgery was excellent physically as they were by definition healthy individuals. The worsening was most significant in the 1st to 3rd month post-operatively, especially in the domains of physical functioning and bodily pain. These and other psychological aspects returned to the previous levels in 6 months’ time. 86.7% (N=26) of these donors reckoned that their donor experience was positive. Conclusion: Donor quality of life was adversely affected immediately following surgery. Return to previous levels could be expected at 6 month in large majority of donors. Live donor liver transplantation seems to be acceptable for the rescue of recipients with end-stage liver disease as adverse changes in donor quality of health is temporary.